The impact of a needs-based educational programme on General Practitioners' confidence and skill in managing common musculoskeletal problems

Disorders of the musculoskeletal (MSK) system are prevalent in the UK. They are a significant cause of pain, disability and health and social care resource utilisation. Most patients with MSK disorders are seen and treated by General Practitioners (GPs). MSK disorders form up to 20% of GP consultations and the majority are formed of a small number of conditions such as back, neck, and knee pain. Despite the prevalence of these conditions, there is evidence that management of affected patients is suboptimal. This thesis investigated the possibility and feasibility of improving GP delivery of care to patients with MSK problems using an evidence-based educational intervention. The study population was a cohort of GPs from Camden and Islington Primary Care Trusts. The first phase of the project was a needs assessment case study of prior training and CME experience in MSK disorders using questionnaires and face-to-face interviews. The second phase used these results to develop, deliver and evaluate an MSK training course. The principal findings from the needs assessment were that formal postgraduate training in MSK disorders was rare. CME events were mainly in the form of lectures. GPs rated the need for knowledge of MSK disorders in primary care as high. The MSK training course was based on the needs assessment, taking place in small groups, using trained patients (Patient Partners) and clinical cases. GPs evaluated the course as highly relevant to their needs, leading to increased confidence and skills. However, GPs estimated that confidence would reduce after 6 months without further training. It is feasible to deliver a research informed training course for GPs on MSK disorders. Further work needs to be done to find effective strategies to produce prolonged changes in behaviour and practice that deliver effective patient care

An Analysis of Poverty at the Local Level

Using primary data from a union council of Punjab (Dhamyal), this article analyses the poverty and inequality at the lower administrative level. The analysis shows that 35 percent of the households are poor while there is wide variation of incidence of poverty among the seven villages of the union council. The highest magnitude of poverty in terms of incidence, intensity, and severity is found in the villages of Hayal and Mohra Bariyan. Location index also demonstrates that these two villages have high concentration of poverty as compared to its population share in the community. Income distribution by quintile shows that the bottom 20 percent households receive 6.7 percent of per capita income share while the upper 20 percent households receive 43 percent of per capita income share. Socio-economic dimensions of poverty reveal that a large number of earners, with large household size, a high dependency ratio, and a high percentage of illiterate head of the household, are marked in poor households. The housing and sanitation conditions of the community show that both poor and non-poor households are deprived of most civic amenities

Human Development in a Changing World

human development, growth, financing development, equity, reform

Does Governance Contribute to Pro-poor Growth? Evidence from Pakistan

Economic growth is a driving force in reducing poverty, but experience has shown that good governance and pro-poor choices are vitally important in the process of alleviating poverty. This paper explores linkages between governance and pro-poor growth in Pakistan for the period 1996 to 2005. The analysis indicates that governance indicators have low scores and rank at the lowest percentile as compared to other countries. The dimensions of pro-poor growth, which include poverty, inequality, and growth, demonstrate that the poor do not benefit proportionately from economic growth. It is found that poverty and inequality have worsened and the share in income and expenditure for the bottom 20 percent has also decreased, while inflation for this lowestincome group is high as compared to the highest-income group. It is also observed that approximately 25 percent households reported that their economic status was worse than in the previous year, 2004-05. The results of the study show that a strong link exists between governance indicators and pro-poor growth in the country. Econometric analysis shows that there is a strong relationship between good governance and reduction in poverty and inequality. It is concluded that greater voice and accountability, political stability, regulatory quality, and rule of law can control corruption and the pro-poor policies, which ultimately reduce poverty and inequality in the long run. To face the challenge of good governance, Pakistan needs to formulate, and implement effectively, its governance policies to improve the governance dimensions, taking account of both higher growth and the aim of achieving the Millennium Development Goals, which require halving poverty by 2015.Governance Indicators, Pro-poor Growth, poverty, Inequality